Medical Billing Specialist

POSITION PURPOSE

The Medical Billing Specialist is responsible for a variety of tasks including, but not limited to, pursuing collection of all claims until payment is made by insurance companies, appealing denied claims, and preparing and submitting billing data to insurance companies.

POSITION LOCATION

The Employee’s primary place of work may be at one or more of the following locations:

The Company’s headquarters located at 8401 Ohio Street Merrillville, IN 46410

ENVIRONMENT

The working environment is an office setting.

DUTIES

• Verifies accuracy of billing data and revises any errors
• Collects and reviews referrals and pre-authorizations
• Answers mail or telephone inquiries regarding rates, routing, or procedures
• Prepares and submits billing data and medical claims to insurance companies
• Follows up with third-party insurance carriers on unpaid claims till claims are paid or only self-pay balance remains
• Calls insurance companies regarding any discrepancy in payments if necessary
• Keeps updated on all billing and benefit changes for third-party insurance carriers
• Monitors claims for missing information and authorization/control numbers
• Ensures the patient’s medical information is accurate and up to date
• Investigates and appeals denied claims
• Maintains billing software by updating rate change, spreadsheets, and current collection reports
• Tracks accumulated hours and dollar amounts charged to each client job to calculate client fees for services
• Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
• Maintains confidentiality of all information
• Performs other related duties as assigned

POSITION REQUIREMENTS

• Knowledge of third-party billing requirements
• Knowledge of insurance guidelines including HMO/PPO, Medicaid and other payer requirements and systems.
• Excellent verbal and written communication skills
• Excellent interpersonal and customer service skills
• Excellent organizational skills and attention to detail
• Excellent time management skills with a proven ability to meet deadlines
• Strong analytical and problem-solving skills
• Ability to prioritize tasks
• Ability to function well in a high-paced and at times stressful environment
• Proficient with Microsoft Office Suite and Excel
• Operate office copy, scan and fax machine
• Must be available full-time hours (Minimum 40 hours per week)
• High School Diploma (or GED or High School Equivalence Certificate)
• Associate degree (bachelor’s degree in business or other related fields preferred)
• Courses in insurance billing, data processing and medical terminology preferred
• 1-3 years of prior experience in billing of third-party insurances for facility and/or professional services
• Experience in ABA therapy billing is highly preferred

PHYSICAL DEMANDS

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.